ABSTRACT

1.Early and frequent antenatal care attendance during pregnancy is important to identify and mitigate
risk factors in pregnancy and to encourage women to have a skilled attendant at childbirth. However,
many pregnant women in sub-Saharan Africa start antenatal care attendance late, particularly
adolescent pregnant women. Therefore they do not fully benefit from its preventive and curative
services. This study assesses the timing of adult and adolescent pregnant women's first antenatal care
visit and identifies factors influencing early and late attendance. The study was conducted in the Ulanga
and Kilombero rural Demographic Surveillance area in south-eastern Tanzania in 2008. Qualitative
exploratory studies informed the design of a structured questionnaire. A total of 440 women who
attended antenatal care participated in exit interviews. Socio-demographic, social, perception- and
service related factors were analysed for associations with timing of antenatal care initiation using
regression analysis. The majority of pregnant women initiated antenatal care attendance with an
average of 5 gestational months. Belonging to the Sukuma ethnic group compared to other ethnic
groups such as the Pogoro, Mhehe, Mgindo and others, perceived poor quality of care, late recognition
of pregnancy and not being supported by the husband or partner were identified as factors associated
with a later antenatal care enrolment (p < 0.05). Primiparity and previous experience of a miscarriage or
stillbirth were associated with an earlier antenatal care attendance (p < 0.05). Adolescent pregnant
women started antenatal care no later than adult pregnant women despite being more likely to be
single. Factors including poor quality of care, lack of awareness about the health benefit of antenatal
care, late recognition of pregnancy, and social and economic factors may influence timing of antenatal
care. Community-based interventions are needed that involve men, and need to be combined with
interventions that target improving the quality, content and outreach of antenatal care services to
enhance early antenatal care enrolment among pregnant women. (McKenzie-Mcharg & Rowe, 2014)

2. We searched for evidence for the effectiveness of emergency obstetric care (EmOC)
interventions in reducing maternal mortality primarily in developing countries. Methods:
We reviewed population-based studies with maternal mortality as the outcome variable and
ranked them according to the system for ranking the quality of evidence and strength of
recommendations developed by the US Preventive Services Task Force. A systematic
search of published literature was conducted for this review, including searches of Medline,
PubMed, Cochrane Database of Systematic Reviews, the Cochrane Pregnancy and
Childbirth Database and the Cochrane Controlled Trials Register. Results: The strength of
the evidence is high in several studies with a design that places them in the second and third
tier in the quality of evidence ranking system. No studies were found that are experimental
in design that would give them a top ranking, due to the measurement challenges associated
with maternal mortality, although many of the specific individual clinical interventions that
comprise EmOC have been evaluated through experimental design. There is strong
evidence based on studies, using quasi-experimental, observational and ecological designs,
to support the contention that EmOC must be a critical component of any program to reduce
maternal mortality. © 2004 International Federation of Gynecology and Obstetrics.
 Published by Elsevier Ireland Ltd. All rights reserved.(Gross, Schellenberg, Kessy, Pfeiffer,
& Obrist, 2011)

3. Maternal distress can have adverse health outcomes for mothers and their children.
Antenatal interventions may reduce maternal distress.\n\nOBJECTIVE: To assess the
effectiveness of antenatal interventions for the reduction of maternal distress during
pregnancy and for up to 1 year postpartum.\n\nSEARCH STRATEGY: EBSCO, Medline,
PubMed, Cochrane, secondary references of Cochrane reviews and review articles, and
experts in the field.\n\nSELECTION CRITERIA: Randomised controlled trials in which the
association between an antenatal intervention and the reduction of maternal distress was
reported.\n\nDATA COLLECTION AND ANALYSIS: Two authors independently
abstracted data from each trial. A random-effects meta-analysis assessed the reduction of
maternal distress associated with antenatal preventive and treatment interventions,
compared with routine antenatal care or another intervention.\n\nMAIN RESULTS: Ten
trials with 3167 participants met the inclusion criteria, and nine trials (n = 3063) provided
data for the meta-analysis of six preventive interventions and three treatment interventions.
The preventive interventions indicated no beneficial reduction of maternal distress (six
trials; n = 2793; standardised mean difference, SMD -0.06; 95% confidence interval,
95% CI -0.14-0.01). The treatment interventions indicated a significant effect for the
reduction of maternal distress (three trials; n = 270; SMD -0.29; 95% CI -0.54 to -0.04). A
sample of women, selected retrospectively, who were more vulnerable for developing
maternal distress showed a significant reduction of maternal distress after the interventions
(three trials; n = 1410; SMD -0.25; 95% CI -0.37 to -0.14).\n\nAUTHOR'S
CONCLUSIONS: Preventive antenatal interventions for maternal distress show no effect.
Antenatal interventions for women who have maternal distress or are at risk for developing
maternal distress are associated with a small reduction in maternal distress.(Fontein-
Kuipers, Nieuwenhuijze, Ausems, Budé, & De Vries, 2014)

4. This paper presents a comprehensive review of the literature surrounding women's

psychological health in pregnancy, childbirth and the postnatal periods. The content will
provide clinically useful information to midwives and health care professionals involved in
caring for women during the antenatal, intranatal and postnatal periods. The impact of
psychological health status in pregnancy on clinical outcomes such as preterm labour, pre-
eclampsia, epidural use, caesarean section, instrumental deliveries and increased rates of
admission to neonatal intensive care, alongside the cognitive and social development of the
infant and child are well documented. Less research to date has considered the impact of
psychological well-being on the mother throughout pregnancy, the peripartum, postpartum
and beyond. Psychological status for these women has traditionally been characterised by
anxiety and depression, largely ignoring the complex psychological interrelations that
characterise pregnancy. Psychological status in pregnancy cannot be defined within a
unidimensional framework but must include a comprehensive assessment of all the
dimensions that attribute to mood and emotional status for women during pregnancy,
childbirth and the postnatal period. This paper intends to address the constructs of anxiety
and depression, worry, control, quality of life, sleep and self-esteem. Screening for, and
identification of, maternal psychological distress from a multidimensional perspective
enables healthcare professionals to recognise and acknowledge normal and abnormal
 adjustment and offer interventions, strategies and support to facilitate a woman's transition
to motherhood. © 2005 Elsevier Ltd. All rights reserved.(Fontein-Kuipers et al., 2014)

5. o analyze the effect of an eccentric-overload training program (ie, half-squat and leg-curl
exercises using flywheel ergometers) with individualized load on muscle-injury incidence
and severity and performance in junior elite soccer players. Methods: Thirty-six young
players (U-17 to U-19) were recruited and assigned to an experimental (EXP) or control
group (CON). The training program consisted of 1 or 2 sessions/wk (3–6 sets with 6
repetitions) during 10 wk. The outcome measured included muscle injury (incidence per
1000 h of exposure and injury severity) and performance tests (countermovement jump
[CMJ], 10-m and 20-m sprint test). Results: Between-groups results showed a likely (ES:
0.94) lower number of days of absence per injury and a possible decrement of incidence per
1000 h of match play in EXP than in CON. Regarding muscle performance, a substantial
better improvement (likely to very likely) was found in 20-m sprint time (ES: 0.37), 10-m
flying-sprint time (ES: 0.77), and CMJ (ES: 0.79) for EXP than for CON. Within-group
analysis showed an unclear effect in each variable in CON. Conversely, substantial
improvements were obtained in CMJ (ES: 0.58), 20-m sprint time (ES: 0.32), 10-m flying-
sprint time (ES: 0.95), and injury severity (ES: 0.59) in EXP. Furthermore, a possible
decrement in total injury incidence was also reported in EXP. Conclusions: The eccentric-
based program led to a reduction in muscle-injury incidence and severity and showed
improvements in common soccer tasks such as jumping ability and linear-sprinting speed.
ABSTRACT FROM AUTHOR(Fontein-Kuipers et al., 2014)

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